Outline:
This disease is also called Osgood-Schlatter disease. It often occurs in young people at the age of 10 - 15, mostly in boys, especially in those boys who often take part in strenuous exercises. A youngster is not rich in kidney qi and not firm in tendon and bone, and his epiphysis of tibial tuberosity is not fused. So, when he practices a violent jump, running and ball games, his quadriceps muscle of thigh will contract strongly, pulling the epiphysis of tibial tuberosity through patellar ligaments, leading to chronic injury, local stagnation of qi and blood and disturbance of blood circulation. As a result, the epiphysis of tibial tuberosity loses its nourishment of qi and blood, hence, there occurs ischemic necrosis.
    
Major points for diagnosis
1. The onset in most cases is slow, and the patient often has a history of recent strenuous exercises.

2. At the beginning, the patient has a pain in the anteroinferior part of knee when walking much or after sport activity, and the pain disappears after rest. Gradually, there occur pain and swelling in the tibial tuberosity, but with no general discomforts; the pain is aggravated by much activity or going upstairs and downstairs, and alleviated by rest. For the case of a long duration or the severe cases, there may appear claudication and lassitude.

3. The tibial tuberosity is prominent with marked tenderness. The local pain is aggravated when the patient flexes his knee through anti-resistance of quadriceps muscle.

4. X-ray film may reveal shadow of swelling and thickening of soft tissues in the final tuberosity, with occasional calcification or small fragments at the early stage; enlargement of epiphysis of tibial tuberosity with irregular appearance and condensation, or fragmentation of bone substance at the middle stage; and irregular hyperplasia of tibial tuberosity, or fusing into a bony protuberance at the late stage.

Herbal therapy
Internal treatment based on syndrome differentiation
(1) Syndrome of qi and blood stagnation
 
Main symptoms and signs:
Pain, swelling and tenderness in the epiphysis of tibial tuberosity aggravated by frequent movement, dark red tongue with thin and yellow coating, and rapid pulse.
    
Therapeutic methods:
Activating qi and promoting blood circulation, harmonizing the nutrient qi to alleviate pain.
 
Recipe and herbs:
Modified Huoxue Zhitong Decoction. The herbs see the treatment of syndrome of blockage of qi and blood in traumatic arthritis.

(2) Syndrome of blockage of collaterals by stasis and heat
Main symptoms and signs:
Protracted disease, local swelling, prominence, heat, redness and pain aggravated after movement, dry mouth with no desire for drink, dark red tongue with thin and yellow coating, and rapid pulse.
    
Therapeutic methods:
Promoting blood flow and clearing away heat, removing the stasis to alleviate pain.
    
Recipe and herbs:
Modified Taohong Siwu Decoction and Wuwei Xiaodu Decoction. Specifically, Shudihuang (Radix Rehmanniae Praeparata ) 10 g, Taoren (Semen Persicae ) 10 g, Honghua ( Flos Carthmi ) 6 g, Chishaoyao ( Radix Paeoniae Rubrae ) 10 g, Danggui ( Radix Angelicae Sinensis ) 10 g, Yanhusuo ( Rhizoma Corydalis) 15g, Jinyinhua (Flos Lonicerae) 15 g, Yejuhua ( Flos Chrysanthemi Indici ) 15 g, Zexie ( Rhizoma Alismatis ) 10 g and Gancao (Radix Glycyrrhizae) 3 g.

External therapy:     
Shangke Xiaoyan Paste or Shuangbai Power may be topically applied; Zhenghonghua Oil may also be externally applied.

Fixation:  
For the case of serious symptoms, a long-leg plaster fixation may be given for 5 to 6 weeks. The patient with severe symptoms should take bed rest. Movement should be restricted or forbidden for the patient with mild symptoms.